Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of...
Transcript of Albert M. Cook Faculty of Rehabilitation Medicine and Faculty of...
Issues in AAC
Albert M. Cook Faculty of Rehabilitation Medicine
and Faculty of Extension University of Alberta
Colloque
2.0 RéadaptATion
-
Aides techniques
13 May 2011
Issues in AAC•
Attitudes impact AAC effectiveness
•
Variety of AAC techniques and strategies
•
AAC is multi-modal•
There are barriers to successful AAC use
Issues in AAC•
Attitudes impact AAC effectiveness
•
Variety of AAC techniques and strategies
•
AAC is multi-modal•
There are barriers to successful AAC use
Attitudes impact AAC effectiveness
•
Family•
Friends
•
Peers•
Strangers
Circle of Friends5
432
1 Client
Fifth circle –
Unfamiliar partners (“everyone else”
who doesn't fit in the first four circles)
Fourth circle –Paid workers (SLP, PT, OT teachers, educational assistant, babysitter)
Third circle –
Acquaintances (neighbors, schoolmates, bus driver, shop keeper)
Second Circle – Close
friends/relatives
First circle life-
long communication partners
Attitudes and Acceptance of AAC by Families
•
Families and peers may be uncomfortable with the AAC strategies because of worries that such approaches might impede the return or development of natural speech
•
Authenticity of the messages and stories that are stored in AAC systems is questioned, especially when SGDs are used.
•
A recurrent theme is whether the individual with severe, chronic aphasia actually authored the messages
Acceptance of AAC
•
Extends beyond individuals with aphasia and includes their family, friends, and peers
•
Families often prefer natural speech for their loved ones
•
People less familiar prefer AAC strategies
Comparison of Mother’s & Fathers AAC GoalsNeed Mother (%) Father (%)Programming knowledge * 4(43.5)Maintenance repair info * 2(48.9)Increasing AAC knowledge 4(46.4) 3(44.7)Integrating AAC at home * 3(44.7)Integrating AAC in comm. 2(44.8) *Integrating AAC in school * 4(43.5)Planning for future needs 5(44.6) 1(50.0)Getting computer access * 5(43.2)More peer social opp. 3(47.6) *More typical social opp. 1(54.1) *
Attitudes of Partners
•
General public•
Children
•
Teachers•
Co-workers
•
Strangers
Attitudes About and Acceptance of Augmentative and Alternative
Communication
•
Factors affecting attitudes toward individuals who rely on AAC
•
Gender•
Type of disability
•
Age, experience of the user of AAC, •
Experience and familiarity with disability and AAC by the partner
•
Social context
Attitudes-General public
Attitudes of children who do not have disabilities toward children who use AAC
Influenced by familiarity with children who have disabilities
Girls are more positive than boys
Older children can be less positive than younger children
Attitudes of children who do not have disabilities toward
children who use AAC
•Much interaction among peers is not affected by AAC system type
•Voice output can lead to more positive peer attitudes than letter displays
Attitudes of children: Meeting a Friend
Attitudes About and Acceptance of Augmentative and Alternative Communication in Classrooms
•Success dependent on attitudes of general education teachers (circle 4) •Students who use AAC & typically developing classmates can develop skills and positive interactions during classroom activities•Unequal status and dissimilar interests lead to social exclusion for students who rely on AAC
Attitudes About and Acceptance of Augmentative and Alternative Communication in Classrooms
•
Peers speak to teacher or assistant not child
•
Concern about lack of academic gain
•
Device features (e.g., speech synthesis) are perceived as disruptive to other students.
•
School-related barriers :–
large class sizes
–
physical layout of the classroom
Attitudes About and Acceptance of AAC in Employment
Benefits:•
Worker: social interaction, personal enjoyment, and financial gain.
•
Employer: positive impacts on other employees, high quality of work loyalty of the employee
Attitudes About and Acceptance of in AAC Employment
Employment challenges •
Finding a good job match to individual skills
•
Communication (e.g., noisy AAC device, speaker phone use)
•
Difficulty with typical office tasks (e.g., manipulation of paper, telephone use)
•
Education or vocational skill level too low
•
Lack of knowledge of work culture
Issues in AAC•
Attitudes impact AAC effectiveness
•
Variety of AAC techniques and strategies
•
AAC is multi-modal•
There are barriers to successful AAC use
Types of Communicators*•
Emergent communicators –
no reliable method
of symbolic expression, here and now concepts only
•
Context-dependent communicators –
reliable symbolic communicating but limited to specific context because:–
Only intelligible to familiar partners
–
Insufficient vocabulary•
Independent communicators –unfamiliar &
familiar partners on any topic
*Dowden and Cook, 2004
Multiple modes for AAC
Some Fundamental Principles in AAC Technologies-each enhanced interaction
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Language organization, storage and retrieval software
•
Abbreviation expansion •
Word completion and prediction
•
Dynamic displays •
EADL as an appliance control w/ IR output
•
Visual Scene displays•
Cell phone capability
•
Scanning –
sequential access
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Selection Methods •
Programmable keyboards
•
Head-pointing & Eye pointing as control interfaces
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Speech synthesis•
Text-to-speech algorithms
•
Digital speech compression
… and more
A wide range of techniques, strategies and technologies are required to support individual’s with complex communication needs (CCN)
Some AAC Options
Cognitive Processing AidsPDA used as prompt for procedures
On screen abbreviation expansion and word prediction for writing
PDA used to aid in memory using pictures for list
PDA-based orientation and way finding
HARD AND SOFT TECHNOLOGIES•
Hard technologies:–
readily available components
–
can be purchased and assembled into assistive technology systems.
–
main distinguishing feature is that they are tangible.
•
Soft technologies:–
human areas of decision making, strategies, training, concept formation,
–
generally captured in one of three forms: people, written instructions or manuals, and computer help screens
–
more difficult to acquireOdor P: Hard and soft technology for education and communication
for disabled people, Proc Int Comp Conf, Perth, Australia, 1984
Mainstream Applications for People With Disabilities
MAINSTREAM DERIVATIVES OF ASSISTIVE TECHNOLOGY*
•
Closed Captioning, Voice Recognition, On- screen Keyboards, Speech Synthesis,
Digitized Speech, Computer Keyboard Equivalents, MouseKeys, StickyKeys, T9 Disambiguation, Word Completion/ Prediction, Abbreviation Expansion, Single Latches on Laptops, On/Off Push button Toggle Switches, Call-out Control Descriptions, Screen Enlargement System, Color Schemes, Wearable Computers, Head Tracking Devices, Brainwave Recognition Units, Single Switch Hardware Interfaces
*Courtesy of R. Marsden…and more
Implications of mainstream derivatives of AT
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Are mainstream technologies more accessible to people with disabilities?
•
Do skills developed in using AT (including AAC technology) carry over to mainstream tech?
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Does this succession of features lead to less need for custom AT?
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Will agencies fund these devices given their greater functionality and applicability to disability needs?
The Potential Downside•
Accessibility of phones, or iPad
•
Will apps really meet needs?•
How robust are the apps?–
Hobbyist kluge vs. professional development
–
Do you get what you pay for?•
Lack of support (Soft technologies)
•
Cultural relevance•
Language
AAC-RERC
White Paper on Mobile Devices and Communication Apps
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Based on interviews with 25 AAC “thought leaders” between January and March, 2011,
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The idea that ANY one device can (or should) “do the job”
for individuals with CCN no longer makes sense
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Many people with CCN, across the age span, require multiple technology options.
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Some needs may be met by mainstream technologies, while others may require accessories and techniques designed specifically for them
•www.aac_rerc.com
White Paper Summary/Conclusions
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The field needs to respond; in some cases provide guidance, and in others determine a new role
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We need to maintain professionalism during this change; partnering will serve the AAC professional better than resistance.
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Keeping the holistic perspective of AAC is crucial
Issues in AAC•
Attitudes impact AAC effectiveness
•
Variety of AAC techniques and strategies
•
AAC is multi-modal•
There are barriers to successful AAC use
How many ways do I have to ask?
Mulitmodal
AAC communication•
AAC is an integrated set of components, including the symbols, aids, strategies and techniques used by individuals to communicate.
•
AAC intervention should always be multimodal, that is, using all the individual communication skills, including vocalizations, residual speech, gestures, signs and aided communication.
American Speech-Language-Hearing Association (1991). Report: Augmentative and alternative communication, Asha, 33 (Suppl. 5), 9-12
AAC Formats
Unaided•
Facial expressions
•
Body language•
Gestures
•
Vocalizations•
Manual sign language
Aided •
Writing
•
Non-electronic communication displays
•
Low tech AAC devices•
High tech AAC devices
•
Software for Mainstream Devices
•
Phone and email
Circle of Friends5
432
1 Client
Fifth circle –
Unfamiliar partners (“everyone else”
who doesn't fit in the first four circles)
Fourth circle –Paid workers (SLP, PT, OT teachers, educational assistant, babysitter)
Third circle –
Acquaintances (neighbors, schoolmates, bus driver, shop keeper)
Second Circle – Close
friends/relatives
First circle life-
long communication partners
Different communication modes are typically used with different partners-as
represented by the five circles
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Communication is Multi-modal Using Multiple Modes to Tell a Story
Michael Williams on various modes and when to use them
Issues in AAC•
Attitudes impact AAC effectiveness
•
Variety of AAC techniques and strategies
•
AAC is multi-modal•
There are barriers to successful AAC use
Issues: Barriers
ParticipationModel
Opportunity Barriers Access Barriers
*Participation Model (Beukelman
& Mirenda)
•
Policies
•
Practices
•
Attitudes
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Knowledge
•
Skills
Opportunity barriers*
Access barriers*•
Environmental Potential:–
Limited natural abilities
–
Natural supports •
AAC potential–
Operational profile
–
Constraints profile–
Capability profile
*Participation Model (Beukelman & Mirenda)
Funding•
Can drive access
•
Balance required between cost and function
•
Can be a major barrier for people with disabilities who depend on assistive technologies and know what they need to succeed
•
Multiple AAC modes can lead to greater cost
Summary of Issues in AAC•
Attitudes impact AAC effectiveness
•
A Variety of AAC techniques and strategies can be used
•
AAC is multi-modal for everyone•
There are opportunity and access barriers to successful AAC use that must be overcome
Questions or comments?